{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:30:55Z","timestamp":1789770655027,"version":"4.0.1"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Objective<\/jats:title>\n This study employed multilevel analysis to examine the impact of the prefecture-level city level variable (number of physicians per 1,000 population) on chronic disease self-management behavior (CDSMB) among Chinese adults, while also investigating the effects of individual-level control variables on CDSMB.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional survey of 1,916 adults across 120 cities, using data from the \u201cPsychology and Behavior Investigation of Chinese Residents\u201d (PBICR), evaluated Chronic Disease Self-Management Behavior (CDSMB) via CDSMS. Key predictors included individual-level control variables: health literacy (HLS-SF12), self-efficacy (NGSES), family health (FHS-SF), and the prefecture-level city level variable of physicians per 1,000 population. Hierarchical linear modeling (HLM) was used to analyze the nested data, with adjustments for demographic covariates.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Vulnerable groups (older adults, rural residents, low-income, education individuals) exhibited significantly poorer self-management (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). At the individual level control variables, health literacy (\n \u03b2<\/jats:italic>\n \u202f=\u202f3.075,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and self-efficacy (\n \u03b2<\/jats:italic>\n \u202f=\u202f1.891,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) positively predicted CDSMB, while family health showed an unexpected negative effect (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22121.784,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). At the prefecture-level city level, physicians per 1,000 population (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.077,\n p<\/jats:italic>\n \u202f&lt;\u202f0.05) explained 17% of between prefecture-level city level variance in CDSMB.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Based on the findings highlighting the influence of physicians per 1,000 population and individual-level control variables on chronic disease self-management, targeted optimization of medical resource allocation and focused support for vulnerable groups are needed to improve chronic disease management.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1712419","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:52:29Z","timestamp":1767768749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors influencing chronic disease self-management behaviors: a national multilevel analysis in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Kai","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1016\/S0140-6736(18)32335-3","article-title":"Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"392","author":"Dalys","year":"2018","journal-title":"Lancet"},{"key":"ref2","author":"Hou","year":"2019"},{"key":"ref3","volume-title":"Report on Chinese residents\u2019 chronic diseases and nutrition 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